Title: Payer and Medical Policy Coordinator Location: Philadelphia United States Job Description: SHIFT: Day (United States of America) Seeking Breakthrough Makers Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation. At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career. CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means. About the Job The Payer-Medical Policy Coordinator supports the Revenue Integrity team by conducting ongoing payer policy reviews, analyzing and interpreting rules to identify material impacts and ensure accurate billing, coding, and reimbursement. You'll track and report all payer policy activity, act as a liaison between Revenue Integrity, Payment Integrity, hospital departments, and hospital-owned revenue-generating areas to ensure charges comply with payer policy, federal and state regulations while optimizing reimbursement. You'll collaborate with Patient Financial Services to resolve denials tied to billed CPT/HCPCS/revenue codes linked to the CDM. This role includes daily maintenance of assigned work queues, supporting special projects as needed, and partnering across the revenue cycle-PFS, HIM, Case Management, Contracting and Reimbursement Services-so strong communication and the ability to interact effectively across the organization are essential. The ideal candidate is highly detail-oriented and maintains a clear, organized process to catalog all payer policies for easy recall and efficient application. This is an excellent opportunity for someone who thrives in a hospital setting and understands the complexities of payer policies and denial management. Work Environment & Flexibility Mostly Remote (Monday-Friday; 8am-5pm) for optimal work-life balance Onsite requirements: Quarterly onsite meetings with team required at CHOP- to inspire teamwork by bringing the group together to plan boldly, connect meaningfully, and innovate for lasting impact. Apply today and help strengthen the financial health of our hospital system-while enjoying the flexibility of a remote role. What you will do 1)Payer Policy Maintenance - meet with Payer Relations team to communicate findings of payer policy reviews - monitoring and interpreting payer policies to help ensure accurate billing, coding, reimbursement. - provide education and training on payer policies - maintaining compliance with government and commercial payer requirements and minimizing revenue loss due to policy misalignment or denials - serves as the subject matter expert for payer policy content and interpretation - prepare reports and presentations for leadership on payer performance and policy impact 2)Coordinate monthly/periodic payer policy updates - Tracking, trending, documenting all monthly payer policies received from Payer Relations. - Identify any policy that may have a material impact and communicate to the Payment Integrity team. - Assess the impact of policy changes on hospital services, including inpatient, outpatient, and ancillary departments. - Collaborate with clinical, HIM, and billing teams to implement necessary workflow or documentation changes - Develop educational documents to be presented, shared with the RCO teams Prepare reports and presentations for leadership on payer performance and policy impact - Develop and maintain a payer policy repository and knowledge base for internal stakeholders 3)New service/New Supply requests - Works with CDM team, providing insight regarding services/supplies determined to be chargeable or not separately chargeable - work with Reimbursement Manager in the analysis and determination of charge pricing and changes - with CDM team for new service/supply requests to help ensure completed requests will be in line with the payer policy interpretations - Support the implementation of new service lines or care models by evaluating payer policy implications. 4)Responsible for analyzing code denials - Ensure policies align with federal and state regulations, payer contracts, and organizational goals - Track and analyze updates to payer policies, including NCDs, LCDs, CCI edits, and commercial payer - Serve as a subject matter expert on payer policy issues and reimbursement strategies - Analyze denial trends and reimbursement data to identify payer-specific issues - Participate in PFS meetings in order to provide feedback on policy issues, denial findings - Analysis of WQ issues, CDM denials for possible recommendation in relation to payer policy trends 5)Responsible for coordinating periodic update meetings with key stakeholders: - including Reimbursement, Compliance, PARC Support - Support contract management teams with policy insights during negotiations - Help to reduce our compliance risks through studying, reporting and making recommendations relative to on- going and emerging coding compliance issues - Participates in project team meetings that involve the review of system programs/services relative to the development of possible changes that impact hospital charge capture or charge entry process - Serves as the subject matter expert for payer policy content and interpretation - Prepare reports and presentations for leadership on payer performance and policy impact Standards for Payer and Medical Policy Coordinator 1)Establishes department standards of excellence. - Annually, reviews, revises and documents all key departmental processes and develops standards of excellence consistent with the Hospital's mission, values, and quality vision. - Compares and integrates industry best practices in the department. - Annually evaluates and measures department's achievement of defined standards of excellence. 2)Establishes integrated systems which improve services and support the Hospital's mission. - Collects and/or reviews data from customer surveys on specific departmental programs or hospital-wide systems. - Uses institution-wide surveys to enhance department services on an ongoing basis. - Annually, participates in and/or contributes to at least one (1) CQI cross-functional and/or departmental quality improvement initiative. 3)Develops, tests, implements and evaluates new and creative approaches to meeting departmental and institutional goals. - Annually prepares written measurable goals for the department. - Participates in a work group to improve departmental or cross-functional processes. - Uses innovative and/or non-traditional approaches to implement changes, which enhance department/institution's ability to meet goals. 4)Integrates trends in healthcare and own profession to forecast future departmental and institutional needs for program development, space, and financial resources. - Initiates at least one realistic tactical/strategic planning recommendation annually based on trend data and/or benchmarking - Makes recommendations for technical enhancements (i.e. tools, software, etc.) which will support the department's vision of increased automation of the necessary work-efforts unique to CDM maintenance. 5)Responds promptly and positively to patients, families, associates, and all others in a respectful, courteous and confidential manner. 6)Follows hospital and department procedures and policies, including but not limited to patient safety, mandatory education, confidentiality, attendance, etc. Licenses and Certifications - Certified Professional Coder (CPC) - AAPC - upon hire - Preferred Education - Bachelor's Degree - Required - Bachelor's Degree Clinical Field - Preferred Experience - At least five (5) years related professional experience in a hospital patient financial services function - Required - Experience with coding, billing and CDM maintenance - Required - At least five (5) years related professional experience in a hospital patient financial services function - Required - At least three (3) years prior supervisory experience - Preferred - Clinical experience - Preferred Required Knowledge, Skills and Abilities - Experience with coding, billing and policy maintenance - Strong database and analytic skills; working knowledge of key computer applications such as EPIC and Microsoft Office suite of products - Ability to promptly recognize, evaluate and manage multiple priorities. - Excellent organizational skills. - Ability to function efficiently and professionally with minimum supervision. - Ability to interact effectively across the organization - Ability to work independently, achieves specific goals and objectives, and provides recommendations for improvement - Ability to work collaboratively with a strong orientation for bottom line results. - Understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, payment models and managed care models. To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more. EEO / VEVRAA Federal Contractor | Tobacco Statement SALARY RANGE: $89,840.00 - $114,550.00 Annually Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

Role Description READY TO ROUND LLC is seeking an organized and customer-focused Patient Coordinator to support healthcare providers with scheduling and front-office operations. This role is essential in ensuring smooth patient flow and a positive patient experience. - Schedule and confirm patient appointments - Answer inbound calls and respond to patient inquiries - Manage cancellations, rescheduling, and follow-ups - Verify patient information and update records - Coordinate with clinical and billing teams - Maintain accurate scheduling systems Qualifications - Strong communication and customer service skills - Experience in scheduling, call center, or admin support preferred - Basic understanding of healthcare environments (a plus) - Ability to multitask and stay organized - Comfortable working in a remote setting Requirements - Experience with EMR/EHR scheduling systems - Prior medical office or front desk experience - Bilingual (a plus, not required) Benefits - Remote work flexibility - Paid training and onboarding - Performance-based bonuses - Career growth within administrative or clinical departments - Supportive and structured team environment Company Description Remote position with coordination through Oradell, NJ office. Works closely with Clinical Support and Billing departments.

Conduct coverage reviews and render determinations based on member benefits. Document clinical findings and engage in peer discussions, while collaborating with providers to ensure accurate benefit determinations and quality medical care for members.

Role Description Instruct and facilitate meaningful learning of the course outcomes in the curriculum and proactively support all facets of the learning environment. Provide education through learning-centered instruction that will enable graduates to fulfill the evolving needs of the marketplace. Encourage a culture of learning that values mutual responsibility and respect, life-long learning, diversity, and ethics as well as personal and professional development. Assure that the South University philosophy: quality service to students; development, growth, involvement, and recognition of employees; and an environment conducive to innovation, positive thinking, and expansion is considered in carrying out the duties and responsibilities of this position. Participate in activities that promote the stature of the academic programs, departments, and colleges and abide by the South University Board of Trustees and administration's mandates. Key Job Elements - Manage the educational process to ensure every student is involved in a positive educational experience through the learning, teaching, and social environment. - Perform faculty responsibilities as outlined in the faculty job description in accordance with the provisions of Faculty Supplement to the South University Employee Handbook. - Provide course instruction that aligns with the South University model of curricula and supports the South University style of system delivery. - Design and deliver instruction through the development of instructional plans to meet course outcomes, the development of activities that support lesson objectives, and for online courses, deliver the instruction as approved within each course shell. - Effectively utilize technology in the classroom to support the student learning experience. - Enable the achievement of pre-defined outcomes for student achievement and evaluation of learning by providing instruction that fosters proficiency and establishes student performance criteria and evaluation. - Deliver learning-centered instruction by establishing an educational environment conducive to learning and student involvement and effectively planning and preparing for classes and student success. - Promote student success by showing flexibility in style and work schedule and exhibiting a passion for teaching and students, and engaging students in the learning process. - Manage the educational environment through keeping accurate records, submitting grades and other reports on time, and enforcing academic and attendance policies consistent with the school, campus, or online division. - Relate professional/life/industry experience to learning by continuing professional/technical skills development, the introduction of industry perspective into courses, and the active awareness of professional/industry trends and opportunities. - Participate in the faculty development process to enhance knowledge, skills, and abilities in learner-centered instruction. - Communicate consistently and effectively with supervisor(s), faculty, and other South University administrators. - Contribute to a learning culture by participating in curriculum and system task forces, support local campus events such as orientation and graduation, and participate in various other workshops and meetings. Qualifications - Clinical professionals with terminal degree or Bachelor’s degree in a health related field with a minimum of 18 semester credit hours completed in the teaching discipline or in a closely related discipline from an accredited program/college/university. - Possess the highest degree in the teaching discipline/field with a certification or license and a minimum of two years’ experience in the clinical field with a minimum of an Associate’s degree. - Clinical and administrative medical office experience, including medical billing and coding (preferred). - At least six months of teaching experience at another post-secondary education institution (preferred). - Membership in a professional association tied to the area of instruction (preferred). Requirements - Academic Processes - knowledge of university guidelines, course descriptions, and academic terminology. - Clerical - knowledge of office administrative procedures, including accurate record-keeping. - Computer - ability to perform basic computer processes, including word processing, web browsing, and utilization of Microsoft Office. - Technical Knowledge and Application - proficiency with the online learning environment, including the creation of digital media and utilization of learning management systems. - Mathematics – ability to perform basic mathematic calculations. - Critical Thinking - uses logic and reasoning to look at different types of information to make conclusions and work through problems. - Research - Locates key facts and information to learn more about different types of information. - Interpersonal Skills - communicates and interacts with people effectively while being aware of social perceptions. - Time Management - manages one's own time to accomplish assigned tasks. - Attention to Detail - thoroughness and accuracy when accomplishing a task ensuring all aspects are reviewed. - Comprehension - ability to read and understand information and ideas presented in writing. - Written Expression - ability to communicate information and ideas in writing so others will understand. - Oral Comprehension - ability to listen to and understand information and ideas presented through spoken words and sentences. - Oral Expression - ability to communicate information and ideas in speaking so others will understand. - Selective Attention (Focus) - ability to concentrate on a task over time without being distracted. - Organizational - ability to organize large amounts of information and tasks. - Teaching - ability to convey course concepts and material in a manner that others can understand. - Engagement – ability to learn from students' participation, demonstrate fair and consistent behavior in all matters, and show compassion without being ineffectual. - Ability to physically work in the United States while performing all responsibilities of the position for the University. - Computing - ability to access a personal computer, Internet connection, and telephone connection (hardware, software, and Internet access specifications to be provided) to fulfill teaching and related administrative responsibilities. - Office Hours - ability to hold required office hours and respond to student questions and administration within the required response time. - Orientation participation - ability to complete the New Faculty Orientation and other assigned/required training (e.g., Code of Conduct) through South University. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The term "qualified individual with a disability" means an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the position. While performing the duties of this job, the employee is regularly required to communicate professionally in person, over the telephone, through email and other electronic means, move about the office or school, handle various types of media and equipment, and visually or otherwise identify, observe and assess. South University is an Equal Opportunity Employer and embraces diversity as a critical step in ensuring employee, student, and graduate success. We are committed to building and developing a diverse environment where a variety of ideas, cultures and perspectives can thrive.